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Cardiorespiratory Fitness & T2D in Patients on Statins

Am J Med; ePub 2017 May 25; Kokkinos, et al

In statin-treated dyslipidemic patients, there is an increased risk of diabetes, but this risk was inversely and independently associated with cardiorespiratory fitness (CRF) and the increased risk was evident only in relatively low fitness patients, a recent study found. Dyslipidemic patients with a normal exercise test performed during 1986 and 2014 at 2 Veterans Affairs Medical Centers were identified. The statin-treated patients (n=4,092, age 58.8±10.9 years) consisted of 2,701 African Americans and 1,391 Caucasians. None had evidence of type 2 diabetes prior to statin therapy. The non-statin treated cohort (n=3,001, age 57.2±11.2 years) with no evidence of type 2 diabetes (T2D) prior to the exercise test served as controls. Researchers found:

  • Incidence of diabetes was 24% higher in statin-treated compared to non-statin treated patients.
  • In the statin-treated cohort, 1,075 (26.3%) patients developed diabetes.
  • Compared to the Least-Fit fitness category, adjusted risk of diabetes declined progressively with increasing fitness and was 34% lower for High-Fit patients.
  • The increased risk of diabetes was evident only in relatively low fitness patients.

Citation:

Kokkinos P, Faselis C, Narayan P, et al. Cardiorespiratory fitness and incidence of type 2 diabetes in Unites States veterans on statin therapy. [Published online ahead of print May 25, 2017]. Am J Med. doi:10.1016/j.amjmed.2017.04.042.

Commentary:

A number of studies have shown that there is a dose-dependent, increased risk of developing diabetes with the use of statins.1,2 Even though statins lead to an increased risk of diabetes, statin therapy is still beneficial for decreasing cardiovascular endpoints in patients who have a high cardiovascular risk profile. Exercise has also been shown to decrease the risk of developing cardiovascular disease.3 In fact, the combination of statins and exercise yields better outcomes than either alone. This study adds to our knowledge, showing that exercise can mitigate the increased risk of developing diabetes in patients who are on statins. This also adds to our reason to encourage exercise for patients who are at increased cardiovascular risk and being put on statins. —Neil Skolnik, MD

  1. Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305:2556-64. doi:10.1001/jama.2011.860.
  2. Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet. 2010;375:735-42. doi:10.1016/S0140-6736(09)61965-6.
  3. Kokkinos P, Myers J. Exercise and physical activity: Clinical outcomes and applications. Circulation. 2010;122:1637-48. doi:10.1161/CIRCULATIONAHA.110.948349.